BRITISH JOURNAL OF SEXUAL MEDICINE, September/October
1997.

Investigation

The nerve supply
of the foreskin
and its role in
sexual sensation
are preserved.

Circumcision
to remove the
foreskin is a
classic,
though
traumatic,
treatment for
phimosis

The causes of adolescent phimosis

In the course of practicing preventive
medicine over the past 15 years, I have carried out
many routine examinations of students in the first year
of higher education. Among males aged 18-22, I have
discovered around 300 cases of phimosis.

The condition occurs in approximately 10%
of the population and is recognized to be present when
the diameter of the preputial orifice is smaller than
the diameter of the erect glans.

The classic treatment for phimosis is
surgical - either circumcision or a simple plastic
surgical procedure that retains the foreskin but widens
its excessively tight orifice.

In view of the fact that this treatment is
essentially bloody and traumatic (and sometimes
mutilating), it seemed appropriate to study the
aetiology of the condition to find out why these males
retain a an infantile foreskin and to determine whether
some alternative simpler and less traumatic treatment
could be devised.

Unusual masturbatory
practices
The history obtained from these patients invariably
showed that their practice of masturbation differed
from the usual manipulation that mimics the dynamics of
coitus and tends to force the preputial orifice back
toward the base of the penis, thus exposing the
glans.

Masturbatory methods used by boys with
phimosis are of several types and I have classified
them as follows.

Some never masturbate.

Some stroke the glans through the foreskin in the
usual way, but attempt to pull the skin towards the
tip of the penis instead of pulling it back toward
the pubis. In these males the long, tubular foreskin
of infancy persists.

In some cases, they roll the penis between two
palms or between one hand and another surface such as
the abdomen, the thigh, a table, the edge of a chair
or the toilet. It is usual in these cases for the
raphe on the underside of the penis not to be in the
midline, but more or less displaced to one side or
even spiral. The preputial orifice is often
displaced.

Mechanical stimulation without the use of the
hands is commonly found. This occurs, for example,
when they lie prone on a pillow and thrust into
it.

Interfemoral stimulation is found.

Correcting phimosis
As a result of this discovery, it seemed logical to
recommend that these patients practise conventional
masturbation. Within a few weeks
(three at the most) it was found that the preputial
orifice became wider, thus correcting the
phimosis.

The method is similar to the kinesitherapy
of soft tissues and is remarkably simple. It is
surprising that it has not been described before.

However, I have known some patients who
have used their common sense and have themselves
modified their practice of masturbation during
adolescence. Furthermore, broaching the topic of
masturbation helps to remove the guilt associated with
a sexual practice that is widespread but often carried
out shamefully because of the taboo attached to it,
particularly in Western society.

Preserving sexual sensation
This medical treatment of adolescent phimosis seemed to
be successful in all cases unless there was some
pathological condition of the foreskin. As a result,
the many problems caused by the amputation of the
foreskin can be avoided.

The nerve supply of
the foreskin and its role in sexual sensation are
preserved and, more importantly, the mobility of the
penile sheath that is necessary to prevent irritation
of the partner's vaginal mucosa is
preserved.